September 22, 2012

You can now hear my latest interview with Jimmy Moore as a podcast. Find it HERE or download it on iTunes.

The topic was "Overcoming Low Carb Problems." Not surprisingly, most of the questions were about not losing weight.

As most of you know my take on the Low Carb diet is that it is an effective way to lower blood sugar. Flattening blood sugar makes us lose the raging hunger that makes so many people with diabetes and prediabetes overeat and gain. So when most people normalize their blood sugar and stop eating the high carb, high calorie junk foods that they used to rely on, they lose weight. Often a significant amount. For a while.

The data I've reviewed, and my years of participating in online diet discussion groups have convinced me that normal weight loss on a low carb diet goes through three phases. A quick weight loss phase where as much as 20 lbs can be lost within weeks--all glycogen, and not body fat, a slower phase lasting up to 6 months when weight comes off at a reasonable pace (a pound a week, for example) and the final phase where weight loss slows to the point where many people can't detect it, get discouraged and quit, though in fact if they stick to the diet they'll lose 1/2 a pound or a pound a month for quite a while longer.

Some people have better results, but since these are the average, for everyone who does better, someone does worse. This isn't because they're doing it wrong--though the doctors who profit mightily from selling magical diet dreams often use that as the explanation for why their magical diets fail real people. These conclusions are supported by lots of academic research and the testimony of decades' worth of online dieters, including that of the small group of people honest enough to admit that their diets haven't lived up to their hopes even when they've pursued them religiously.

Many people have a false idea of how their weight loss should proceed on a low carb diet because the online Low Carb and Paleo cultures are dominated by young, fit men, and doctors whose only experience of weight loss is knocking off 10 or 20 pounds in middle age. You rarely hear the voices of older women and those with serious metabolic problems. (Jimmy is a refreshing exception to this rule, but he's also an outlier. Very few people lose 200 lbs their first year on this or any other diet.)

So newbie dieters in the latter categories often assume that they will experience the same results as these vocal, young, healthy proponents of the diet who can lose steadily eating 2500 calories worth of delicious high fat food every day. But this ignores the fact that a 220 lb 35 year old man with a healthy metabolism may easily be able to lose weight while eating twice as much food as a 200 lb 55 year old woman. No matter how often that woman goes to the gym or how low her carb intake.

That's why many of the questions on this call in show were from older women and people with metabolic issues who thought there was something wrong with them when they couldn't lose on the kind of regimen that works for the outspoken, young, male proponents of these diets.

There isn't. For most older women with serious weight problems, losing weight means cutting way down on calories no matter what the macronutrient composition of their meals, and even then, weight loss will be slow--half a pound a month is not unusual after the first five or six months. Cutting carbs eliminates the appetite problem that make it so tough to cut back on food, but cutting carbs without cutting calories only works during the heady first few weeks and months of the diet. After that, it's time to get out the food scale, weigh portions, look up the nutritional value of what's on your plate, figure out how much your body burns daily, and eat significantly less than that amount every day for months and perhaps years to come.

This argument explains why my book Diet 101: The Truth About Low Carb Diets isn't a runaway bestseller. But it also explains why it's getting rave reviews on Amazon from people who say things like, "No BS here, folks" and " It was almost shocking to read a book that was completely honest on this subject -- no pie in the sky promises, just realistic statements and expectations supported by fact."

Another issue I discuss in response to questions on this live show was something the diet and weight loss surgery do their best to keep you from learning: most people never get to their diet goals, even when they amputate their stomachs and make it impossible to eat anything but an ultra low carb/low food diet.

I dug in and looked at some stats from WLS studies and found that a surprising number of people did not lose more than 50% of their excess weight even on these extreme regimens that force people to eat low carb. At best, most people lose 80% of their excess weight. If that's the best people can do on a forced ultra low carb/low food diet, it makes sense that a free range low carb diet is not going to get most people to their weight loss goal--because most people's weight loss goals, when they start out very overweight, are simply not realistic.

My own experience with polling the Low Carb community is that while there are some lucky people who do get to their goals, they are few in number. Most people lose 20% of their starting and then weight loss slows way, way down. If they stick to it, some can lose more, but if they push too hard, some end up with weight losses that can only be maintained by staying on a very rigid, low calorie diet for the rest of their lives. It's much harder to maintain on that kind of stringent regimen than it is on one that lets you feel like you're eating a reasonable amount of food.

That's why I often advise people to lose what you can lose without starving yourself, then work on maintaining that loss. Appreciate your victories. If you've normalized your blood sugar you won't end up with diabetic complications, even if you still weigh more than you'd like. Focus on maintaining what you have lost, however much it is. Maintaining a modest weight loss for a decade or more is a huge achievement--far healthier, harder, and more impressive than losing a lot of weight and regaining it all five years after your weight loss effort began.

All this is discussed in this podcast, but if you want to go into any of these topics in depth, I'd suggest reading my book, Diet 101: The Truth About Low Carb Diets. If you only get the simplified, pre-chewed version of diet advice that fits onto a web page or an interview, you will never learn all you need to know to truly understand your metabolism. We live in a society that caters to those who are too lazy to dig in, read, study and think. But it is by doing just that that you'll put yourself in a situation where you won't have to ask any expert or rely on their advice no matter how wierd, because you'll have the tools needed to evaluate all claims and chose the health strategies most likely to work for you in your own, individual circumstances.

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comments:

When I started insulin, I logged all my meals and doses. After a year, I sat down and looked at the data and discovered when eating as desired (I wasn't dieting except to stay mostly low-carbish, under 100 g/day). That year, I had averaged 1400 calories per day AND NOT LOST WEIGHT!

And yet, when I started ThreeLac, I lost all kinds of weight without trying. 45 lbs in 6 months, even being pretty naughty with diet the whole time (cause I was discouraged at the time).

The point NOT being that ThreeLac is "the answer".

The point being that we don't KNOW what the answer is. Anyone who tracks obesity research even slightly can see that it's not just calories, it's not just exercise, it's not just carbs.

Aiming at health INSTEAD of weight loss is realistic. I didn't start GAPS to lose weight. To me, it will prove successful IF I can reduce my Novolog ratios. That is how I'll measure if it "works" for T2 diabetes.

I have had a ridiculously good response to Coenzyme Q10, much stronger than anyone I've heard from, and it's gotten me to where I can eat near normally with only metformin. Another example of how unique we all are.

Jenny, you said: I dug in and looked at some stats from WLS studies and found that a surprising number of people did not lose more than 50% of their excess weight even on these extreme regimens that force people to eat low carb.

What is a WLS study? I'd like to see them for myself. Did these studies include a higher ratio of fat, or did they just cut carbs? I am an older women (53) who has had great success with my low carb diet (went from 173 to 132 pounds, which is my ideal weight, and have maintained the loss for over a year now without difficulty). I learned that I must eat a higher ratio of fat to protein and keep my carbs low, or I stop losing weight.

I am skeptical of many of the studies out there, because just eating low carb isn't the only factor. I think low carb/high fat gets closer to what we need, and from what I've been able to find, there are very few good quality low carb/high fat studies out there. Gary Taubes and Peter Attia recently launched NuSI (you can read about it on Gary Taubes blog) to try to address the many questions about nutrition with better research studies, and I'm hopeful we will have better data soon.

Is it possible that many of the failed dieters you have talked to have not understood the importance of high fat/moderate protein/low carb? When we cut carbs AND cut fat, and it gets much harder to lose any weight.

I'm not saying that you're wrong, and that this diet will work for everyone. But I am a case of an older woman who has done this diet and had exactly the results I should have had - by not only cutting my carbs, but by also keeping my fat content high.

By the way, I first tried cutting calories instead of increasing fat, and it didn't work. Weight loss still stalled. I started adding a tablespoon or two of virgin coconut oil to my hot tea, and the weight just fell off of me. It still does, if I accidentally eat too many carbs and gain a few pounds I want to lose quickly.

WLS is Weight Loss Surgery. It makes it impossible to eat more than a few teaspoons full of food and eating carbs provokes vomiting. You can find studies about the weight loss it causes using Google

Your experience with coconut oil is, unfortunately, not common. There are many dozens of posts on the Low Carb Friends BBS from people who tried that strategy only to find that they gained weight when they added coconut oil. There are also people shilling coconut oil on bulletin boards, who appear to work for the companies who sell it, so I am always cautious about such reports.

i have a question, one woman started to touch on it but not really. do you know how vlc diet effects your ft3 levels? does it drop in ALL people who are vlc or even lc? and is this necessarily a bad thing? can you have a pretty low ft3 and be asymptomatic of hypothyroidism? i know a lot of people who test their ft3 levels are already sick.

The coconut oil is just my fat of choice. WLS is an extreme measure, and if one can only eat a few teaspoons of food, they are eating a starvation diet, not what would be considered a healthy low carb diet.

I was really asking you what you think of low carb/moderate protein/high fat, and if your experience with failed dieters includes dieters who faithfully followed such a protocol.

The evidence suggests that some but not all people may have a problem with T3 when they eat low carb diets, but the problem is that it converts to a form of T3 that isn't distinguished from the active form in testing, so testing T3 won't reveal this problem. The problem is solved by raising carbs over 105 a day. This is discussed in my book, Diet 101: The Truth About Low Carb Diets.

Low carb, moderate protein, high fat is the right way to do an LC diet, but yes, plenty of people who eat that way, self included, have stalled for long periods of time.

People who earn their livings promoting one specific diet tend to exaggerate the benefits and excuse the problems with the diets. And as I believe Jimmy mentioned, those who have the highest profiles in the LC community (and who earn the biggest book advances) tend to blame anyone who doesn't succeed on the diet.

On Jimmy's show you said that you began to have heartbeat irregularities when your cabs were too low. I too have had this problem and cannot seem to drink enough water to offset the electrolyte imbalance from the water loss. All of the water I drink goes right through me. Adding salty broth does not seem to work because too much salt causes my hands to swell. Everything is more pronounced after waking in the morning when I am more dehydrated. Other symptoms that I have noticed include joints that click and pop and lower back pain in the kidney area.

My question is this. Is it possible to remain in ketosis and not have the unpleasant symptoms? The trick seems to be trying to maintain the body's water while in ketosis. The challenge is the period when we are asleep. Drinking excess water right before bed results in too many trips to the bathroom and not enough sleep. This diet is not quite as simple as it may appear. Getting the food right is only part of it.

The burning off of glycogen seems to deplete potassium, and that is what seems to cause the electrolyte irregularities.

The only way to counter it probably is to supplement with potassium. But that can be dangerous, too, as too much potassium will also cause heartbeat problems, and worst case can be fatal. Don't supplement with potassium at all if you are taking blood pressure drugs until you talk to a pharmacist. Quite a few blood pressure drugs are "potassium sparing" and extra potassium will cause dangerous levels to build up.

In theory, after you burn off the glycogen the electrolytes should stabilize, but I have found I do better if I keep my carbs high enough to avoid the problem, which for me was 30-40 net grams (net of fiber) as opposed to 20.

Jenny, I was the second question asked on the show. I wanted to thank you for your answer. I have since lowered my calories to 1150 and can tell a difference already. For my size everyone (Doc) think this is not enough calories. But for eight months I have done it their way and maintained my current weight. You mentioned you need 1400 to maintain your small frame. So it was well worth the try! Middle age and all the changes is a learning curve for us all. I love living grain free and so does my blood sugar. I maintain a 5.6 A1C for the last 2 years. No meds. Hope to keep it that way. Love your website and all the helpful information you have posted. Thank you for sharing.Deby in Michigan

Hi Jenny, great interview at Jimmy's. I consider you and your Diet:101 to be my primary sources when introducing newbies to low-carb.

Two comments:

Don't discount the glycogen / water loss. Carrying a gross burden of excess glycogen may be as damaging to mitochondrial health as too much fat. You're sucess with CoQ10 may be an indicator for you.

Also, I really appreciate your discussion of realistic weight-loss expectations. I am a 6-foot,59 year-old male and have gone from 302 lbs down to 215 over two years on low-carb. BMI is still 29.5 and waist is still over 40, but a skin fold test shows 13.5% body fat. Look at me and you would say I look fine. But my body simply does not conform to today's simplistic popular charts and formulae.

Our goal should be health and fitness, not vanity. I will never look like I am 25 again, and I really don't care.

I mean that I can eat 50 grams a meal and see fasting blood sugars in the 80s and low 90s, 1 hr readings well under 140 and 2 hour readings usually under 110 mg/dl and often in the 90s.

In the past when eating a strict low carb diet my fasting blood sugar would hover around 108 mg/dl. Eating fifty grams would have put me up between 250 and 275 mg/dl. My blood sugars were like that back last December (when I had gone back on insulin for that reason), but after taking CoQ10 they normalized.

This is baffling and not, apparently, something other people experience. I'm very grateful for it, but wish I understood what was going on. My blood sugar was very stable for most of the last 14 years and the only other thing that lowered it dramatically was Prandin, a drug that is known to be very helpful for people with MODY which is what I appear to have.

The downside of the CoQ10, however, was that it also ramped up my immune system to where I was having overwhelming responses to things like spider and horsefly bites, both of which caused massive swelling, and itching and made my joints painful, which hadn't been a problem before.

I have gone off the CoQ10 for the past two weeks but am still seeing very good blood sugars.

That's what I hear from most people. I only tried it because I heard from a man in the UK that the NHS would pay for it for some people with certain forms of genetic Diabetes and that he found it helpful.

It was on sale at CVS so I figured, why not try it? The result was a shock. I used a low dose (50 mg)and any more makes me very hungry, which makes me wonder if perhaps low doses are more effective for this use than the much higher ones people usually use. The only studies I found come to the opposite conclusions. One worked, one didn't. But the formulations used were different.

That said, my guess is that this points to some peculiarity of my own diabetes, which probably won't be anything I can figure out. I know I don't have mitochondrial diabetes because my mother's blood sugar was 100% normal. I got my diabetes from my father. Usually it is mitochondrial diabetes that responds to CoQ10. But since the one study I saw of people with Type 2 found an impact, there probably is something there.

i lost 15 pounds in the first 3 months of low carb and then stalled. but after those 3 months my 6 month pregnancy look went down to a 3 month one. was the visible loss of weight probably all glycogen? what does glycogen loss look like??

thank you for your super informed and compassionate take on weight loss and blood sugar control.

Glycogen loss shrinks your liver making your tummy smaller and your muscles causing you to lose those "inches" they like to measure at the gym to convince you exercise is helping when the scale stalls.

But typically you lose glycogen mainly during the first week, and depending on how heavy you are, maybe the next two weeks. After that weight loss should be mostly body fat if you are eating enough protein. If not, some of it is fat and some of it muscle mass.

I take the same amount of metformin as before. Metformin doesn't make very much of a difference in my blood sugar (about 10 mg/dl), but it keeps me from being hungry, plus I appreciate its anti-heart attack, anti-cancer properties.

It's a huge mistake to blame breast cancer on anyone's lifestyle. There is growing evidence that the severe forms of it are heavily influenced by genes. Recently the gene that causes ovarian cancer was linked to a subset of fatal breast cancers, for example. If one has a susceptible gene it can be triggered by exposure to common organic molecule pollutants, age, exposure to radiation, and many other factors.

Metformin does seem to help when we look at large populations, but it may not be able to counteract specific genetic problems.

If it were me, I'd talk to my gynecologist about getting tested for the known genes that can cause the really nasty form of breast cancer, because if you have it, they will screen you more aggressively.

Otherwise, yes, enjoy life and come to terms with the fact that none of us gets out of here alive. I've seen people devote themselves to eating perfectly, only to die in freak accidents, or of strange conditions no one ever worried about. Thin, healthy people die of cancer. (Fat, diabetic people live to be very old, too, which I find encouraging.)

Younger people tend to cling to false beliefs that basically say that if they do everything right they will live forever. I see a lot of that kind of thinking in the online diet community.

There are things we can prevent--most notably diabetic complications, and we should do what we can to avoid them, but we should never kid ourselves that we control the manner of our exit--or that we will exit life, probably at some time which isn't the one we'd have chosen. Either too early, or as I saw in the elders in my family, much, too late.

this health thing has gotten to be such a strong interest of mine, that i think i have been letting it make me feel that i am guaranteeing myself a long, healthy life. which is just silly. my father-in-law took really good care of his health and died when he was hit be a truck. he always kept in mind life was short, though.

i talked to the coroner who did his autopsy- his arteries were clean as a whistle. that's a weird conversation to have. he was such a good person. then there was my grandsfather who lived to be rich, mean, and in good health almost all the way to 94.

there are no guarantees, so we better appreciate the moment. thank you for reminding me of this and making it more emotionally real instead of just intellectually so.

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I was diagnosed with diabetes in 1998. Since then I've kept my A1cs in the 5.0-6.0% range using the techniques you'll find explained at The main Blood Sugar 101 Web Site, where you'll also find extensive discussion of the peer-reviewed research that backs up the statements you read here.

I've also published two books on related subjects, Blood Sugar 101: What They Don't Tell You About Diabetes, which was an Amazon Diabetes bestseller for 3 years and Diet 101: The Truth About Low Carb Diets.